This invention relates to a new and improved surgical device and method for end-to-side vascular anastomosis without requiring vascular clamps that constitutes a part of by-pass procedures and a new apparatus comprising an external tubular stapler for connecting a by-pass vascular graft to an anastomosing sheath.
The use of vascular clamps poses difficulties during an endoscopic anastomosis due to the small space available for maneuvering the various surgical instruments employed in this procedure. There is also a possibility of inadvertently injuring the arteriosclerotic arterial or aortic wall when using partial vascular clamps. The apparatus and method of this invention have particular use in conjunction with Applicant's application, entitled: "END-TO-SIDE VASCULAR ANASTOMOSING STAPLING DEVICE"; Ser. No. 09/033,035; filed: Mar. 21, 1998, now U.S. Pat. No. 5,951,576.
Typical publications describing these procedures are described in U.S. Pat. Nos. 2,935,068; 4,154,241; 4,366,819; 4,368,736; 4,505,414; 4,523,592; 4,553,542; 4,598,712; 4,650,486; 4,657,019; 4,747,407; 4,747,818; 4,930,674; 4,931,057; 4,966,602; 5,188,638; 5,222,963; 5,267,940; 5,392,979; 5,403,333; 5,425,761; 5,437,684; 5,443,198; 5,456,714.
However, these patents do not provide a method and/or equipment for performing a vascular anastomosis without temporarily occluding an artery or aorta, partially or totally, and which would be suited for endoscopic vascular end-to-side anastomosis. Hence, a method and/or equipment are desired which can be applied to a by-pass procedure in general, and to an anastomosis procedure in particular. Additionally, a procedure and means are desired which provide a strengthened connection between a by-pass graft and a vein or artery, irrespective of the type of by-pass equipment (employed, and which would be useful, particularly in confined spaces or with a small vein or artery.
Additionally, it is desired to provide an apparatus and method for end-to-side anastomosis of a coronary artery by-pass graft without requiring a heart-lung apparatus and associated equipment, such as a blood oxygenator. Also, it is desired to provide a method and/or equipment which eliminates a partial or total vascular clamping procedure. Since a considerable period of time may be consumed when sewing or stitching is employed for anastomosing a vascular graft with a coronary artery, a total vascular clamping procedure during this time period may jeopardize tissues downstream from the clamping site due to lack of an adequate blood supply.